She has a terrible secret. But she keeps up a good front.
Outwardly the teen, whose name, like others interviewed for this article, will be withheld because of her age, seems like any bubbly 17-year-old. She seems cheerful and laughs easily. She won't mention any problems, not even to the Elmhurst Hospital volunteer who has helped her weekly with homework for several months.
But the Colombian-born girl complains privately of alienation and hating her mother. And she tried to kill herself earlier this year.
There are many like her in Queens -- severely depressed Hispanic adolescents who hide suicide attempts and other troubles behind a mask. In more traditional pockets of the community, to talk about mental illness is considered shameful. Many patients take months before they will trust anyone, even a doctor.
"Over time we find that they express themselves in ways that indicate depression, from irritability to attempted suicide," said Dr. Douglas Beer, the director of child psychiatry at Elmhurst Hospital.
Suicide is the third leading cause of death in 15- to 24-year-old Hispanic-Americans. Latinos comprised the largest proportion of American high school students who tried to take their lives, a 2007 Center for Disease Control survey found. It showed that 10.2 percent of Latino high school student had tried to kill themselves, compared to 5.6 percent of whites.
The pattern is seen in Queens, home to half a million Hispanics and where up to 50 percent of Elmhurst Hospital's adolescent patients seeking mental help are Latino.
One such case involves a 15-year-old Mexican girl who attempted suicide earlier this year. A rape so traumatized her that she was fearful all the time. "I want to stay in the hospital because I am scared of going out on the streets," she said. During interviews though, she declined to share details about happened, avoiding eye contact and fidgeting as she spoke.
Tensions between American-born children and immigrant parents cause much of the alienation, doctors say. "The dynamics between second- or third-generation teenagers and their parents play a part in the onset of suicidal tendencies and adolescent depression," said Dr. Sergio Aguilar-Gaxiola, a professor of Internal Medicine at the University of California Davis. "Many Latino children feel conflicted between the traditions at home and the American way of life they learn at school."
Local doctors cite clashes in which immigrant-born parents reject the behavior of their Americanized children. Dr. Beer said a typical conflict would involve teenage girl whose suicide attempt stems from her parents disapproval of her dating. "Suddenly it's not a simple emergency room [suicide] case," he said. "There are all these other elements we have to consider like the boyfriend, the girl and her parents as well as the cultural factors at play."
Hispanic adolescents face challenges similar to other immigrant groups, such as having to translate for their parents and adapting to two different worlds. But Latino teenagers also face a stigma about mental health treatment, said Dr. Daniella Heller, assistant director of psychiatry at Elmhurst Hospital.
Although statistics show that 15 to 20 percent of Hispanic adolescent patients at the medical facility are admitted for trying to take their lives, there are still a significant number of afflicted teenagers who never seek help.
"They are scared to be seen as crazy if they seek help; it's seen as a weakness in the Hispanic community that comes from the deep-rooted stigma associated with mental health problems," said Theo Oshiro, director of health advocacy for Make the Road New York, a non-profit advocacy group that deals primarily with the Latino community in New York.
There is also a lack of awareness about mental illness and treatment options. Three doctors interviewed said that many hospitals, including Elmhurst, lack sufficient staff who speak Spanish and understand the culture.
Also, many undocumented immigrants are terrified of speaking to officials. "There is the fear of deportation that makes many Latino parents unwilling to bring their children in for depression treatment," Dr. Heller said.
Among the Latinos who do seek treatment for mental health, an estimated 75 percent do not return for a second time said Dr. Aguilar-Gaxiola. "This is a hot potato policy," said the Mexican-born psychiatrist. He explained that even in facilities where Spanish translation is available, the cultural stigma associated with seeking mental help among Latinos makes it difficult to address the afflicted.
Mental health staff are largely white non-Hispanics, unlike their patients, echoed Dr. Beer of Elmhurst Hospital. "We face the challenge of not only [not] having Spanish-speaking staff, but [not] having people who can even identify themselves as culturally Hispanic," he said.
Dr. Heller, who is Colombian born, handles most of the Latino cases and the facility is in the process of hiring more such staff as well as developing Latino-specific adolescent mental health programs.
"We try our best," said Dr. Beer. "But there are challenges and barriers all around."